Doctors at the Jackson Memorial Hospital faced a novel issue when a 70-year-old man was brought into the emergency room after being found intoxicated and unconscious on the street. (The man lived at a nursing home and had a history of pulmonary disease). The doctors were working to assist the man when someone noticed a large chest tattoo reading “DO NOT RESUSCITATE.” It even had a tattoo signature. After consulting an “ethics expert,” the hospital treated the tattoo as a viable DNR form and allowed the man to die. In my view, the expert was wrong on the law if his decision was based solely on the tattoo.
Florida agencies have a specific form and states:
Do Not Resuscitate Order—Form 1896 (Multilingual)
Important! In order to be legally valid this form MUST be printed on yellow paper prior to being completed. EMS and medical personnel are only required to honor the form if it is printed on yellow paper.
The form has a place for a physician’s signature and required showings of informed consent. Florida does not recognize a metal DNR bracelet or necklace. A patient may carry a “patient identification device”, a smaller version of DH Form 1896 for their wallet or even a chain.
The problem is that “Do Not Resuscitate” teeshirts and tattoos are common jokes. There was no way that the staff could determine if this was a joke or waiver.
A similar case was discussed in a 2012 article in the Journal of General Internal Medicine, involving a 59-year-old patient. He had “D.N.R.” tattoo across his chest but he said the tattoo was a joke and the result of losing a bet in poker.
In this case, there are reports that the the hospital may have been able to secure an DNR order from the patient that was signed previously. That would obviously impact the decision greatly and support a DNR decision. It would be the waiver not the tattoo that should be determinative.
The question is whether to err on the side of life and the answer in my view is clearly yes. The staff should not have made an assumption that this tattoo was meant as a substitute of a DH Form 1896 or constructive waive of resuscitation.
The controversy was discussed in the New England Journal of Medicine,
What do you think?